Dementia strategies in an aging society: Policies, care, and global insights from the Japanese experience.

The proportion of elderly in Taiwan reached 11.99% of the population in 2014. Further, Taiwan is expected to become a super-aged society, as defined by the United Nations, in 2025. Elderly and long-term care needs have increased dramatically and long-term care (LTC) has become an increasingly important focus of policymaking. Japan, already a super-aged society, enacted LTC insurance in 2000 and has since implemented comprehensive LTC services nationwide. This article describes the evolution of the LTC insurance plan in Japan and the function of the Community Inclusive Care System. The latter integrates medical care, homecare services, LTC services, living support, and Community Integrated Support Centers with public-health nurses, social workers, and care managers in order to facilitate the construction of services that enhance aging in place. The authors hope that learning from Japan's experience in developing LTC will facilitate the future development of LTC services in Taiwan.

Preferences for private long-term care insurance products in a super-ageing society: A discrete choice experiment in Hong Kong.

Dementia prevalence across the globe is in alarming proportion and it is even expected to rise in the future. The World Health Organisation (WHO) had declared dementia as a health priority, way back in 2009 and had recommended then, that at least high-income countries develop a dementia action plan, and other countries develop a national dementia strategy (NDS). Later in 2014, European Countries came together to sign the Glasgow Declaration and agreed to develop their respective NDSs. Yet, a few countries still do not have their NDS. Moreover, some countries do not have their NDS in English. This study attempts to compare the dementia strategies of 17 European countries, which has a comprehensive NDS in English language. The study further examines how well these NDSs comply with the Glasgow Declaration and the WHO's Global Action Plan guidance. Cluster analysis is undertaken to classify NDSs of these countries in terms of similarity in the content. Word clouds are used to get an overall idea about the clusterwise contents of the NDSs, and then an algorithmic approach to content analysis is applied for identifying the clusterwise key focus areas of these dementia strategies. A comparative analysis of these NDSs in the perspective of dementia prevalence, demographic profile, per capita gross domestic product (GDP) and predominant healthcare financing model. The findings suggest that irrespective of the prevalence, country's demographic profile, GDP per capita or the predominant financing model, dementia strategies primarily focus on "care", implying the compliance of post-diagnostic support. Germany addresses almost all the fundamental rights of the Glasgow Declaration. Countries differ in their compliance with the key action areas of the WHO's GAP, though post-diagnostic support is addressed by the dementia strategies across the clusters, whereas 3 out of 7 KAAs are not addressed by dementia strategies in any of the clusters.

Dementia prevalence across the globe is in alarming proportion and it is even expected to rise in the future. The World Health Organisation (WHO) had declared dementia as a health priority, way back in 2009 and had recommended then, that at least high-income countries develop a dementia action plan, and other countries develop a national dementia strategy (NDS). Later in 2014, European Countries came together to sign the Glasgow Declaration and agreed to develop their respective NDSs. Yet, a few countries still do not have their NDS. Moreover, some countries do not have their NDS in English. This study attempts to compare the dementia strategies of 17 European countries, which has a comprehensive NDS in English language. The study further examines how well these NDSs comply with the Glasgow Declaration and the WHO’s Global Action Plan guidance. Cluster analysis is undertaken to classify NDSs of these countries in terms of similarity in the content. Word clouds are used to get an overall idea about the clusterwise contents of the NDSs, and then an algorithmic approach to content analysis is applied for identifying the clusterwise key focus areas of these dementia strategies. A comparative analysis of these NDSs in the perspective of dementia prevalence, demographic profile, per capita gross domestic product (GDP) and predominant healthcare financing model. The findings suggest that irrespective of the prevalence, country’s demographic profile, GDP per capita or the predominant financing model, dementia strategies primarily focus on “care”, implying the compliance of post-diagnostic support. Germany addresses almost all the fundamental rights of the Glasgow Declaration. Countries differ in their compliance with the key action areas of the WHO’s GAP, though post-diagnostic support is addressed by the dementia strategies across the clusters, whereas 3 out of 7 KAAs are not addressed by dementia strategies in any of the clusters.

Background With the global population ageing rapidly, achieving healthy ageing is crucial, especially in countries like South Korea, where over 14.2% of citizens are aged 65 and older, qualifying it as an ‘aged society’. By 2050, the Asia-Pacific region is expected to see unprecedented ageing, with 10 countries classified as 'ageing societies' (over 7% of its population aged 65 and over), five as 'aged societies' (over 14% aged 65 and over), and 11 as 'super-aged societies' (over 21% aged 65 and over) with South Korea as anticipated to be among the latter, projected to have over 40% of its population aged 65 and older. Effective nutritional assessment for this demographic remains challenging due to limitations in conventional methods, exacerbated by factors like cognitive decline and low literacy. Despite efforts to address these challenges with new technological solutions like web, scanners, and mobile-based tools, issues of accuracy, usability, and cost persist. Therefore, this study aims to introduce and evaluate a speech-based dietary assessment tool as a promising alternative for older adults. Method In a randomised cross-over design, 18 participants aged 65 and older were divided into two groups, each using both a pen-and-paper food diary (FD) method and a speech recognition dietary assessment (SR) method over two weeks. Dietary intake was recorded and analysed over non-consecutive 3-day periods each week while usability was assessed via the Systems Usability Scale (SUS). Results The results of the nutrient intake analysis indicated small mean differences between methods, with a 0.49% difference in energy and an average of 5.02% in essential nutrients. Significant correlation coefficients for nutrient intake between methods were observed, with the highest for fat (0.740), protein (0.738), and dietary fibre (0.671). Bland-Altman analysis indicated no substantial bias in energy or essential nutrient intakes, except for cholesterol which showed a discernible proportional bias. SUS scores between the SR and FD methods showed no statistical significance; however, the SR method received a higher standardised rating, characterised as 'acceptable' with a score of 72.77, compared to the FD method, rated as 'marginally acceptable’ with a score of 66.25. Conclusion These findings suggest that the SR method is adequately comparable to the traditional FD method for dietary intake assessment in older adults and is on par in terms of usability, indicating its potential as a valid and acceptable alternative. Trial registration KCT0009677

Public health planning for dementia must start now

Objectives The shortage of professional caregivers is a critical issue in care facilities, which are a key social resource in the community-based integrated care system for Japan's super-aging society. However, professional caregivers report a high intention to continue working. This study aims to reveal the factors surrounding working intentions among professional caregivers, from a positive perspective, using a qualitative design.Methods A qualitative design, based on a content analysis approach, was used in this study. From August to November 2018, semi-structured joint interviews, using the interview guide, were conducted with 14 experienced professional caregivers working in 11 care facilities for the elderly in Japan. The participants were paired, or grouped, into three groups and were interviewed. The interviews, recorded with participant approval and transcribed in their entirety, were analyzed. The researchers identified and categorized common themes emerging from the participants' responses to each question as codes. We raised the abstraction level of the codes into subcategories, and subcategories to categories. Approval was obtained from the Institutional Ethics Committee of Setsunan University (No. 2018-018).Results The average age of the participants was 35.0±6.45 years. Three categories, consisting of nine sub-categories across 27 codes, emerged as the main themes. The first was 'attachment to care work for older adults,' which consisted of three sub-categories, which included "love of and enjoyment in dealing with older adults." The second was 'cohesion in the workplace and linkage inside and outside the workplace,' which consisted of sub-categories, such as "cohesion of rational workplace members." The final category was 'supportive workplace management and human resource development from an on-site perspective,' which consisted of sub-categories, including "psychological rewards and support from superiors." These findings revealed that attachment to care work for older adults and the work environment influencing attachment are important factors concerning their work intentions.Conclusion We found that 'attachment to care work for older adults,' 'cohesion in the workplace and linkage inside and outside the workplace,' and 'supportive workplace management and human resource development from an on-site perspective' were factors that affect the work intentions of professional caregivers. The findings suggest that encouraging professional caregivers to continue working, using measures that foster attachment to work, and which develop their work environment, such as cohesion and linkage based on human relationships, are required.

BackgroundSince 10 years ago, Japan has been creating a long-term vision to face its peak in the number of older people that will be reached in 2025 when baby boomers will turn 75 years of age. In 2003, the government set up a study group called “Caring for older people in 2015” which led to a first reform of the Long-Term Care Insurance System in 2006. This study group was the first to suggest the creation of a community-based integrated care system.ReformsThree measures were taken in 2006: ‘Building an active ageing society: implementation of preventive care services’, ‘Improve sustainability: revision of the remuneration of facilities providing care’ and ‘Integration: establishment of a new service system’. These reforms are at the core of the community-based integrated care system.DiscussionThe socialization of long-term care that came along with the ageing of the population, and the second shift in Japan towards an increased reliance on the community can provide useful information for other ageing societies. As a super ageing society, the attempts from Japan to develop a rather unique system based on the widely spread concept of integrated care should also become an increasing focus of attention.

The world population is aging. The proportion of the population over 60 will nearly double from 12% in 2015 to 22% in 2050. Global life expectancy has more than doubled from 31 years in 1900 to 72.6 years in 2019. The need for long-term care (LTC) services is expanding with the same rapidity. A comprehensive response is needed to address the needs of older adults. Learning from health systems in other countries enables health systems to incorporate best long-term care practices to fit each country and its culture.This symposium aims to compare long-term care policies and services in Taiwan, Singapore, and the USA where significant growth in aging populations is evidenced. In 2025, the aging population will be 20% in Taiwan, 20% in Singapore and 18 % in the USA. In the case of Taiwan, it has moved from aging society status to aged society, and to super-aged society in 27 years. Such accelerated rate of aging in Taiwan is unparalleled when compared to European countries and the United States. In response to this dramatic change, Taiwan has passed long-term care legislation that expands services to care for older adults, and developed person-centered health care that integrates acute and long-term care services. Some preliminary results related to access, care and patterns of utilization will be shared in the symposium. International Comparisons of Healthy Aging Interest Group Sponsored Symposium.

In modern society, the average life spans of peopleare being extended thanks to rapid economic growth,improvement in living standards, and medical tech -nology development. The ratio of elderly persons tothe entire population that was 11.0% in 2010 is ex-pected to become 14.3% in 2018 so that our societybecomes a 'aged society' and become 20.8% in 2026 sothat our society becomes a 'super-aged society'.Therefore, population aging is coming to the fore asa serious social problem(1).Such rapid increases in aged populations can causemajor social problems in many aspects of the societysuch as decreases in the working population result-ing from aging and increases in medical expensesand welfare budgets. In addition, various elderlyperson problems will occur including physical, social,and psychological problems. Out of the entire agedpopulation, 81.5% have pain and body parts wherepain mainly occurs are the knee at a ratio of 62.3%and the lumbus at a ratio of 60.6% indicating thatmusculoskeletal system problems account for a largeportion of elderly person problems(2).Due to the aging phenomenon appearing in elderlypersons' musculoskeletal systems, calcificationoccurs in tendons and ligaments and the widths orsizes of muscles decrease so that muscle strengthand muscle endurance decline(3). Muscle strengthgradually decreases by approximately 10% in 50s, byapproximately 15% per decade in the 60s and 70s andby approximately 30% per decade thereafter(4).These declines in muscle strength and the skeletoncause diseases such as low back pain. The recom -mendation revised by American College of SportsMedicine in 2010 encourages elderly persons to performactive medium intensity aerobic exercise for fivedays per week or perform medium or high ntensityphysical activities for 3∼5 days per week to maintainhealth and improve functional abilities(5). Among low back pain related exercise programs,pilates exercise is body stabilization exercise that notonly develops muscles in the abdomen, the thora -columbar region, the buttocks, and the inner side ofthe thigh to straighten the vertebrae and the pelviswhich are the center of the body but also preventscoronary artery diseases and reduces the risk ofrespiratory diseases(6). Pilates largely comprises mat

Despite the soaring demand for long-term care (LTC) services in aging societies, dedicated risk-pooling mechanisms are largely absent. Private insurance has been advocated but the market remains small. This study seeks to unravel this paradox through an empirical study in Hong Kong, a super-aging society. We analyzed middle-aged individuals’ willingness to purchase hypothetical private LTC insurance plans derived from a discrete choice experiment. A survey was conducted in 2020 and sampled 1,105 respondents. We noted a fairly encouraging level of acceptance but also found clear barriers toward potential purchase. The desire for self-sufficiency and preference for formal care powerfully increased individuals’ interest. Cognitive difficulty, habitual adherence to out-of-pocket payment, and unfamiliarity with the LTC insurance market reduced such interest. We explained the results with reference to the changing social dynamics and drew policy implications for LTC reforms in Hong Kong and beyond.

This article examines what is known and what we need to know about rural long-term care populations and the formal and informal service systems that support their long-term care needs. The article provides a framework for identifying some of the critical policy and research questions concerning the financing and delivery of rural long-term care that merit the attention of health services researchers and policymakers. It documents differences in the demographic and health characteristics of the rural and urban elderly and in the availability, organization, and use of health and long-term care services in rural areas that have significant implications for long-term care policy and programs. With this background in mind, the author discusses specific topics and questions relevant to long-term care policy and program improvements for rural communities and people: (a) the changing role of the rural nursing home; (b) residential care alternatives in rural areas; (c) health personnel and rural long-term care; (d) the quality of rural long-term care; (e) innovations in long-term care financing and service delivery; (f) use of technology in rural long-term care; and (g) the effects of Medicaid and Medicare policy changes on the rural long-term care system.

Background: Canada’s National Dementia Strategy (NDS) is on its way, but it has come late compared to other countries. The healthcare system is managed by provincial governments, and each of them has its own strategy in place but there appear to be differences between each province’s approach to the disease. Objectives: Compare the current dementia strategies for the six Canadian provinces and assess the common points to integrate each province’s plan into a Canadian NDS. Methods: Data obtained for this review was obtained from each provincial government’s platform. Endpoints were assessed by following the framework used in the literature to review Dementia Strategies by country. The primary endpoints were: priority actions and key actions; the secondary endpoints included were: years active, stakeholders, funding, and implementation. Results: This review carefully examines the key aspects of provincial dementia strategies and inspects common ground between the different strategies with the goal of proposing comprehensive recommendations towards a NDS for Canada. The priority actions that were common to all provinces were Creating Awareness, Research and Knowledge Transfer, Caregiver Support, End-of-life Care, and Training of Physicians and other health care professionals. Conclusions: There is a need for a NDS in Canada, but when elaborating this strategy, provincial factors need to be considered as each province faces different challenges and each population responds to different needs. A proper NDS will have limited but elemental Priority Actions, allowing for provinces to include their own Key Actions following the national strategy.

Dementia prevalence across the globe is in alarming proportion and it is even expected to rise in the future. The World Health Organisation (WHO) had declared dementia as a health priority, way back in 2009 and had recommended then, that at least high-income countries develop a dementia action plan, and other countries develop a national dementia strategy (NDS). Later in 2014, European Countries came together to sign the Glasgow Declaration and agreed to develop their respective NDSs. Yet, a few countries still do not have their NDS. Moreover, some countries do not have their NDS in English. This study attempts to compare the dementia strategies of 15 European countries, which has a comprehensive NDS in English language. The study further examines how well these NDSs comply with the Glasgow Declaration and the WHO’s Global Action Plan guidance. We undertake cluster analysis to classify NDSs of these countries in terms of similarity in the content. We make use of word clouds to get an overall idea about the clusterwise contents of the NDSs, and then use algorithmic approach to content analysis for identifying the clusterwise key focus areas of these dementia strategies. We make a comparative analysis of these NDSs in the perspective of dementia prevalence, demographic profile, per capita gross domestic product (GDP) and predominant healthcare financing model. We have found that irrespective of the prevalence, country’s demographic profile, GDP per capita or the predominant financing model, dementia strategies primarily focus on “care”. We discuss the cost-effectiveness of prevention and person-centered care (PCC) and suggest according priorities to these in the future NDSs, as these are also the focus areas of Glasgow Declaration and the GAP.

PurposeThe purpose of this paper is to examine the health sector reform toward 2040 of Japan as a super-aged society.Design/methodology/approachThis paper discusses the current healthcare policies adopted in Japan and projects the challenges in future as a super-aged society.FindingsThrough Japanese experiences, it is considered that Community-based Integrated Care System is useful, which takes into account the perspective of health care users. Being a super-aged society, it is essential for Japan to have more consensus by further removing obstacles, and paying attention to the change of paradigm and the purpose of care.Originality/valueBased on the case of Japan, this paper serves as a reference for other East Asian countries, which would sooner or later encounter the similar situation of becoming super-aged societies in the 21st century.